Anxiety and Depression in Cerebral Artery Dissection: A Multidimensional Pilot Study

Background: Cerebral artery dissection is a major cause of stroke in young and middle-aged adults. However, the prevalence of anxiety and depression among patients with cerebral artery dissection, their potential associations with cerebral artery dissection, and the underlying biological mechanisms remain poorly understood. This study aimed to describe anxiety and depression in patients with cerebral artery dissection and to explore potential bidirectional associations and candidate biological processes. Methods: Clinical prevalence and subgroup differences of anxiety and depression in cerebral artery dissection patients were assessed using clinical data. Mendelian randomization (MR) analyses were conducted to evaluate associations between anxiety, depression and cerebral artery dissection. Peripheral-blood RNA sequencing identified cerebral artery dissection-associated differentially expressed genes, which were integrated with anxiety-related genes from GeneCards for enrichment analysis of candidate shared biological processes. Results: Among 726 cerebral artery dissection patients, 315 (43.4%) had anxiety symptoms and 303 (41.7%) had depressive symptoms, with higher proportions in males, ever-smokers, and ever-drinkers. MR analyses provided preliminary evidence of a potential bidirectional association between anxiety and cerebral artery dissection, whereas no consistent evidence of an association was observed between depression and cerebral artery dissection. Integration of cerebral artery dissection-associated differentially expressed genes and anxiety-related genes identified 33 overlapping genes enriched in mitochondrial energy metabolism-related pathways, suggesting candidate systemic transcriptional signatures shared by anxiety and cerebral artery dissection. Conclusions: Anxiety and depression symptoms were frequently observed among patients with cerebral artery dissection. Genetic and transcriptomic analyses suggested potential links between anxiety and cerebral artery dissection, involving candidate mitochondrial energy metabolism-related processes that warrant validation.